NP Licenses and Liability

Off topic here a bit

I don't understand how extra skills = extra liability. There are always cases where a little knowledge, but not enough, is dangerous. However, there are also many cases where mistakes are made for many other reasons. The nurse needs to stay within the scope of practice of the licensed role they are fulfilling - if at the bedside, then it's the RN scope.

Certainly, the immediate transition - from NP back to bedside - would be more risky, but a transition period is always more risky - such as new grads to practicing RNs.

You are held to the scope of your highest certification. If an NP went to work as a CNA (to use an extreme example) then they would still be held to the standard of a NP. Since NP's diagnose and treat this now opens up liability for the hospital as the employer. This is covered wonderfully in this article which is referenced for the umpteenth time:

http://www.medscape.com/viewarticle/506277_7

Your state law of course may cause things to be different. From a different perspective we checked with our carrier about hiring an ANP to work in our endoscopy center as an RN and the premium went up about $4000 for the facility (on a $50k bill). They were very careful to phrase in such a way that if it was a MSN with no APN training it did not change liability.

David Carpenter, PA-C

Above posts moved to single thread and retitled - to maintain continuity.

I became a CNS in May 06. I had previously worked as a staff nurse for 10 years in the ER and loved it. However, I couldn't get hired now as staff because i am held to a higher level of care.

:offtopic: - licenses and liability

Take that NP working as a CNA... as a CNA it's not their responsibility to diagnose or treat. Wouldn't their responsibility end with notifying an appropriate person of a problem? If the assigned RN didn't take action, then perhaps the additional responsibility of the NP/CNA is to take it to another level, such as reporting to the charge nurse that patient A needs a nursing assessment, the RN has been notified and hasn't responded in a timely manner. The difference for the CNA would be that they'd have no legally defendable reason of why they shouldn't trust that the nurse was taking care of everything properly. Am I off here?

What if the NP lets their NP license lapse? Is differential liability still an issue? I imagine this is a concern for all those NPs practicing as RNs.

I'm curious about this issue because I've got an RN license and was told I couldn't be hired onto an LVN position at a local hospice. The only RN role they had was as nurse manager and I didn't want that responsibility right off the bat. I didn't want any extra compensation as an RN - just the experience working in that setting. But they said that the job was for an LVN and that's why they couldn't hire me.

My understanding is that even if you are working in the CNA role you are still held to the highest standard of training. It is an artifact of nursing that you have what is essentially two licenses. In other areas of medicine you are not allowed to have more than one active license. For example I had to give up my Paramedic license when I became a PA. If I remember correctly there is an example on studentdoctor where a PA that went back to med school was able to moonlight as a PA while in med school. However, once he got his license in residency he could no longer do that (and could not moonlight as an intern either). Interestingly in my state you can have an active PA license and a chiropractic license since chiropractic is not considered the practice of medicine.

As far as surrendering a NP license I am not sure how that would work. You may still carry liability for a higher standard from your training despite your licensing or you may devolve to the standard of training of an RN. I think it would depend largely on the state. Also depending on your state you may be able to structure your job duties so that you are not held to a higher standard.

David Carpenter, PA-C

You are correct David. I hold an RN license, a CNS license, a pre-hospital RN license, and of course the controlled substance license. Both the RN and CNS license must remain active in order for me to continue to practice. Unsure why you would have to give up your paramedic license. I use my pre-hospital RN license to volunteer on my local fire dept.

You are correct David. I hold an RN license, a CNS license, a pre-hospital RN license, and of course the controlled substance license. Both the RN and CNS license must remain active in order for me to continue to practice. Unsure why you would have to give up your paramedic license. I use my pre-hospital RN license to volunteer on my local fire dept.

In Colorado Paramedics are licensed under the BOM. You cannot hold two active medical licenses here. That being said I can ride as a PA and do everything and more that I did as a Paramedic as long as I have a supervising physician with a scope of practice that allows me to do that.

David Carpenter, PA-C

Another point on this is the hospital may not care about the added liability. For a small business a 10% increase in liability is pretty big. For a hospital it may not be noticeable. There are quite a few RNs working around here in the ICU that are trained as NPs (although I am not sure if they have taken the certification exam or gotten their NP license).

David Carpenter, PA-C

David C. - you say you could ride as a PA. Does that mean you could be hired to a paramedic position? You'd be a PA, not a paramedic, I get that. But could a company legally allow to you work the same position as a paramedic since you have comparable (and more) skills?

I know it sounds strange to ask as why would a PA want to work in a paramedic role anyway? But perhaps the hours are more flexible or you're moving to a location that doesn't utilize PAs much. Or maybe you decide in the end that you were happier working as paramedic than as a PA. When I asked in the general forum before about why RNs couldn't work in LPN roles, I got a number of incredulous responses about why anyone would even consider that.

It's the whole "overqualified" dilemma. If for whatever reason you don't have a job at your trained level, it's hard to get a job "below" your level. But usually that's because employers figure that you'll quit as soon as something better comes along, not because it's illegal for the person to work below their training.

You would not be working as a paramedic in this case. You would be working as a PA that is doing prehospital medicine. You would have the full scope of practice for a PA. Pridemark uses PAs in this role. Usually it involves going to nursing homes and doing procedures. It gets around having to credential somebody at each facility. This is typically task based such as central line insertion or dobhoff placement.

Its not that I would want to work as a Paramedic. The issue comes up when a PA wants to volunteer for a local fire department for example. If you want to provide medical services you need a license to do that. Some PAs sought to use their paramedic license which our board did not allow. It would be a similar issue if a physician that was previously a paramedic tried to work as a paramedic to escape liability issues. In this case since the physician is still held to the physician standard no matter what the role.

I think that you are describing a similar issue with the LPN. I also see a number of other problems from an operational standpoint. If a hospital is allowed to hire a RN at LPN wages I would guess the other nurses would be fairly upset. I would also guess that there would be supervision and delegation issues. Could a LPN supervise and RN even when working in a LPN role (I work in hospitals without LPNs so I really don't know how this works).

David Carpenter, PA-C